College of American Pathologists
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September 2006

Raymond D. Aller, MD
Hal Weiner

No need to shop ‘til you drop, thanks to Web-based EMR service
A case for making toll-free border-free
Olympus America acquires Bacus Laboratories
Antek HealthWare and GE announce systems interface
Federal regulations for health information technology updated
IDM releases new version of blood donor system
Fletcher-Flora offering new middleware solution
SNOMED CT integrated in drug knowledge base
DCL and OntoReason partner on SPL label translation and coding

bullet No need to shop ’til you drop, thanks to Web-based EMR service

If, as the adage says, a stitch in time saves nine, then Eric S. Fishman, MD, is a tailor of sorts.

Recognizing that physicians can become bogged down in a multitude of choices when shopping for an electronic medical record system, the former orthopedic surgeon offers through his Web site individualized guidance on selecting an appropriate EMR., which Dr. Fishman founded in 2004 and offers free to physicians, uses a proprietary computing method to help physicians and medical groups select the EMR software that best fits their practice. The service uses a database of about 300 EMR vendors, about a third of which have filled out a survey consisting of 600 questions, the answers to which provide detailed information about their systems, Dr. Fishman says.

Physicians also complete an online survey, which takes half an hour to an hour, depending on whether they choose the shorter version, consisting of about 100 questions, or the longer version, which has about 300 questions. The survey asks, for example, about the physician’s specialty, EMR software budget, and whether the program will be maintained on a client server or using an application service provider, Dr. Fishman explains.

The Web-based service generates about five vendor recommendations per request, which Dr. Fishman then evaluates for their applicability to the physician’s needs. Clients usually receive recommendations via e-mail two to four days after they’ve submitted the survey.

Any EMR manufacturer can be listed in the database as long as the vendor provides enough information to make a meaningful match with a physician, Dr. Fishman says. Interested vendors fill out a form on the Web site. Physicians also recommend that specific vendors be listed in the database, Dr. Fishman adds. recently began using Matrix, a color-coded matching system. For example, if a physician wants to spend between $10,000 and $15,000 on an EMR system, but a manufacturer’s package costs $50,000, Matrix will highlight in red that manufacturer, meaning it will be excluded from consideration.

“When I first started this, I had a large number of results frequently land up at the 99th percentile,” says Dr. Fishman, meaning that for any given physician, nearly all the manufacturers were deemed a match. “And, I realized that wasn’t that helpful. So, I got much more sophisticated.”

Dr. Fishman spent about nine months in 2005 revising the questionnaires for physicians and vendors and improving the methodology used to perform the matching function. He released the second version of late last year. Dr. Fishman has applied for a patent on the algorithm and methodology used to match physicians with vendors.

Thousands of people have accessed the service, Dr. Fishman says, and he has made thousands of recommendations. Dr. Fishman gave up his surgical practice about three years ago to focus on, but he still sees patients daily in his office-based practice.

While the service is free to physicians, some vendors pay a fee to participate. Dr. Fishman notes that his recommendations do not depend on whether he has a referral fee agreement with a vendor. He adds that he generally doesn’t track which recommendations turn into leads.

For now, he generally relies on the vendors to notify him when a recommendation has led to a sale. An employee may also call clients to get feedback on the service, and that sometimes leads to knowledge of a sale. This inconsistent tracking of sales is “a flaw in the business model,” he says, “but one that I can live with today.”

bullet A case for making toll-free border-free

Many health care organizations use inward wide area telecommunication services, or WATS, more commonly known as “800 numbers,” to make it easier for patients and providers to reach them. To save costs, these telephone numbers often have limited access—that is, a hospital sets up its service so only callers within that state can use the number. This worked fine for many years—until the cell phone boom.

One local health organization had a long-established 800 number for immediate reporting of contagious disease. Fortunately, the institution periodically hired a consulting group to test all of its systems, including its phone system. The consultant, who had flown in from the opposite coast, got a “cannot be reached from your calling area” message when he dialed the institution’s toll-free number, yet he was only three miles from the building at that moment. The organization’s information technology staff subsequently determined that the phone system thought—from the area code of the cell phone being used—that the caller was on the other side of the country.

Given the mobility of today’s population—a couple I know are living in San Diego yet have cell phones with area codes for Washington, DC, and Georgia—we can no longer afford to limit emergency call-in systems based on calling area.

—Raymond Aller, MD

bullet Olympus America acquires Bacus Laboratories

Olympus America has acquired Bacus Laboratories, a vendor of virtual microscope slide technology and microscope software for clinical laboratory applications.

By securing Bacus’ patents and software capabilities as part of the transaction, Olympus has gained access to virtual microscope slide and telemedicine technology, allowing the company to offer a comprehensive virtual microscope slide system.

Among the products to be sold by the combined company is the comprehensive Bliss system, designed for a single workstation, which combines an Olympus microscope and Olympus’ service and training with Bacus’ software.

Under the acquisition, Bacus becomes a wholly-owned subsidiary of Olympus America, retaining its name.

bullet Antek HealthWare and GE announce systems interface

Antek HealthWare has announced that its LabDaq laboratory information system can be interfaced with GE Healthcare Information Technologies’ Centricity electronic medical record system, providing clients with a real-time flow of patient demographics, insurance, billing, ordering, and results information.

bullet Federal regulations for health information technology updated

The U.S. Department of Health and Human Services has announced new regulations to support physician adoption of electronic prescribing and electronic health records technology. The final rules, one from the Centers for Medicare and Medicaid Services and the other from the Office of the Inspector General, create new exceptions and safe harbors to two federal fraud-and-abuse laws.

The CMS rule creates two new exceptions to the physician self-referral law, which prohibits a physician from referring Medicare patients for certain designated health services to entities with which the physician has a financial relationship, unless an exception applies. The law also prohibits the health care entity from billing for Medicare services that are furnished as a result of a prohibited referral.

Similar to the CMS rule, the OIG rule establishes two new safe harbors under the federal anti-kickback statute. Arrangements involving the provision of items and services that meet the requirements of the safe harbors are exempt from enforcement action under the federal anti-kickback statute related to electronic prescribing as well as electronic health record systems.

The exceptions and safe harbors establish conditions under which:

  • Entities furnishing the Department of Health and Human Services (and certain other entities under the safe harbor) may donate to physicians (and certain other recipients under the safe harbor) interoperable electronic health record software, information technology, and training services.
  • Hospitals and certain other entities may provide physicians (and certain other recipients under the safe harbor) with hardware, software, or information technology and training services necessary and used solely for electronic prescribing.

The scope of donors and recipients under the final rules is considerably broader than in the proposed rules. Donations protected under the exception may be made to any physician by entities furnishing the Department of Health and Human Services. The exception requires compliance with criteria similar to those listed in the electronic prescribing exception, as well as additional criteria, such as those requiring cost sharing and selection of physician recipients of donated technology.

The corresponding OIG safe harbor is similar. However, consistent with underlying statutory differences, the safe harbor covers a broad array of providers, suppliers, practitioners, and health plans when they provide electronic health record technology to physicians and other health care providers.

For additional information about the new regulations, go to the U.S. Department of Healther and Humarn Services Web Site (Click on the appropriate entry for Aug. 1, 2006).

bullet IDM releases new version of blood donor system

Information Data Management has introduced Prelude 1.2, the latest revision of its donor room management system.

Prelude 1.2 offers a questionnaire manager module, which allows users to configure new health history questions and forms, and it permits a repeat donor to self-register at a kiosk with the swipe or scan of a donor card. Prelude 1.2 also features an automated installation and upgrade tool.

IDM’s Prelude system contains a self-administered donor interview, supports a paperless blood donation process, captures a donor’s photograph and digitized signature, and provides remote mobile blood drives with the same functions as fixed sites.

bullet Fletcher-Flora offering new middleware solution

Fletcher-Flora Health Care Systems has released FFlexConnect, interface middleware to seamlessly integrate its EncaLaber laboratory information system and remote lab locations.

FFlexConnect uses secure Internet technology to manage the transfer of information between local or remote workstations and the LIS server in the main lab. It supports communication and manages the flow of information between an EncaLaber LIS and printers, label writers, devices, instruments, and third-party clinical system interfaces.

FFlexConnect is integrated with EncaLaber and comes standard with each implementation or added remote location. Fletcher-Flora Health Care Systems,

bullet SNOMED CT integrated in drug knowledge base

First Databank Europe has upgraded its Multilex Drug Data File by integrating SNOMED CT and the NHS Dictionary of Medicines and Devices.

First Databank Europe, or FDBE, says the new release is designed to support customers in meeting NHS Connecting for Health requirements, including the National Care Records Service and Electronic Prescription Service. The update is available as part of FDBE’s standard product offerings, which are focused on providing clinical decision support to practitioners in a variety of health care settings.

The Multilex Drug Data File is a drug knowledge base in the United Kingdom that can be integrated into a variety of clinical systems in hospitals, community pharmacies, physician practices, and other health care settings.

bullet DCL and OntoReason partner on SPL label translation and coding

Data Conversion Laboratory and OntoReason have entered a strategic partnership to deliver SPL labels in the FDAPhysician Labeling Rule format, complete with coding of prescription drug label highlights. The combined service allows pharmaceutical companies to quickly convert paper-based prescription drug label information to the FDA required HL7 Structured Product Label standard.

DCL is working with more than 75 sponsors worldwide to facilitate compliance with the FDA’s SPL initiative. OntoReason provides national standards-based terminology and vocabulary services coupled with intelligent processing. Its health ontology and terminology services have been tailored to provide the pharmaceutical industry with automated SPL coding services coupled with detailed expert review and code-selection documentation.

Dr. Aller is director of bioterrorism preparedness and response for Los Angeles County Public Health Acute Communicable Diseases. He can be reached at Hal Weiner is president of Weiner Consulting Services, LLC, Florence, Ore. He can be reached at